纱布条加压对PICC术后穿刺点淋巴液渗漏的预防效果

Effect of local pressure with gauze strip on prevention of lymphatic leakage at puncture site after PICC procedure

目的 探讨纱布条局部加压在经外周静脉穿刺置入中心静脉导管(PICC)术后预防穿刺点淋巴液渗漏的效果。方法选取2021年1—12月新乡医学院第一附属医院收治的96例拟行PICC的患者,采用随机数表法分为联合组与敷料组,每组48例。2组患者均于PICC术后行穿刺点3M透明敷料固定,联合组患者加用纱布条局部加压。比较2组患者穿刺点淋巴液渗漏发生率、渗液量以及穿刺上肢肿胀情况。结果 联合组患者淋巴液渗漏发生率为12.50%(6/48),低于敷料组的29.16%(14/48),差异有统计学意义(χ^(2)=4.042,P=0.044)。联合组患者中等渗液发生率为0.00%(0/48),低于敷料组的12.50%(6/48),差异有统计学意义(χ^(2)=4.444,P=0.035);联合组患者中无渗液者比例为87.50%(42/48),高于敷料组的70.84%(34/48),差异有统计学意义(χ^(2)=4.042,P=0.044)。联合组、敷料组患者置管后上肢肿胀发生率分别为12.50%(6/48)、8.33%(4/48),差异无统计学意义(χ^(2)=4.447,P=0.504)。结论 在敷料固定的基础上给予纱布条局部加压能够降低PICC术后穿刺点淋巴液渗漏风险,减少渗液量,且不会加剧上肢肿胀发生风险。

Objective This paper aims to explore the effect of local pressure with gauze strips on the prevention of lymphatic leakage at the puncture site after the peripherally inserted central catheter(PICC)procedure.Methods Ninety-six patients scheduled for PICC from January to December 2021 at the First Affiliated Hospital of Xinxiang Medical University were randomly assigned to two groups:the combined group(n=48)and the dressing group(n=48).Both groups were fixed with 3M transparent dressing at the puncture site after the PICC procedure,while the combined group was additionally treated with local pressure with gauze strips.The incidence,and amount of lymphatic leakage at the puncture site,as well as upper limb swelling,were compared between the two groups.Results The incidence of lymphatic leakage in the combined group was significantly lower than that in the dressing group[12.50%(6/48)vs.29.16%(14/48);χ^(2)=4.042,P=0.044].The incidence of moderate leakage in the combined group was significantly lower than that in the dressing group[0.00%(0/48)vs.12.50%(6/48);χ^(2)=4.444,P=0.035].The proportion of patients without leakage in the combined group was significantly higher than that in the dressing group[87.50%(42/48)vs.70.84%(34/48);χ^(2)=4.042,P=0.044].The incidence of upper limb swelling after catheterization was 12.50%(6/48)in the combined group and 8.33%(4/48)in the dressing group,with no statistically significant difference(χ^(2)=4.447,P=0.504).Conclusion Local pressure with gauze strip based on dressing fixation can reduce the risk of lymphatic leakage at the puncture site after the PICC procedure,decrease the amount of leakage,and does not increase the risk of upper limb swelling.